Health Level 7 (“HL7”) is a healthcare information technology (“IT”) standards body that is responsible for establishing the messaging protocols for the electronic transmission of information among IT systems used in the healthcare industry. The HL7 communications protocols allow IT systems offered by different solutions providers (and even different systems offered by the same solutions provider) to communicate with each other in a standardized fashion. Laboratory Information Systems (“LIS”), Hospital Information Systems (“HIS”), Electronic Medical Records systems (“EMR”) and specialized systems that facilitate Computerized Physician Order Entry (“CPOE”) are among the types of systems used by healthcare providers that typically support HL7 messaging as a standard method for communication. When information originated by one system must be shared with others, those systems are likely to require a specialized interface to do so. This is almost always true when the communication is between unrelated healthcare institutions, but it can also occur when systems within the same institution need to communicate.
The LIS, HIS and other healthcare IT systems produce information that is important to the diagnosis and treatment of patients. At times, this information is important to public health officials; most of the information that public health officials act upon in investigating incidents of communicable disease comes from reports of diagnostic test results confirming the incidence of infectious disease in a patient. As a result, electronic communication between LIS, HIS and other healthcare IT systems and the systems used by public health officials is important. For example, if a laboratory receives a diagnostic test result indicating that a patient may have a communicable disease, the laboratory is usually required by law to notify designated public health officials of the existence of the condition. Depending upon the circumstances, the physician who has ordered the test may also be required to report the positive test result to the public health department. While this type of reporting has traditionally been handled using manual processes such as telephonic reporting and/or mail or fax transmission of paper forms, the transmission of this information can be (and increasingly is being) handled in an automated fashion, using system-to-system communications often employing point-to-point interfaces. In situations where one or more steps in the notification process are handled electronically, the HL7 protocol has been the typical method of transmission. For reasons stated below, it is now the method mandated by the federal government.
As a result of a federal government initiative under the direction and control of the Centers for Disease Control and Prevention in Atlanta (“CDC”), a framework of coordinated standards and specifications, called the Public Health Information Network (“PHIN”), is now being advanced to facilitate the electronic transmission of information about communicable disease incidents from local public health departments to the CDC. PHIN will also perhaps facilitate the sharing of information among public health departments nationally. While the system was originally conceived as a disease surveillance network, in recent years its mandate has been expanded to include detection of incidents or outbreaks events that may indicate a bio-terrorist attack has occurred or is taking place. The CDC's vision for this network depends upon communication among healthcare providers, local, state and public health officials. The CDC might have mandated that all of these potential participants in the network use the same IT system to communicate. Instead, it chose to delegate responsibility for the deployment of IT systems to the participants themselves, leaving each free to adapt existing systems, build or buy new ones, so long as these systems were “interoperable” based upon criteria established by the CDC. One of the primary criteria for determining “interoperability” is the capability of each system to transmit messages using a standard format and structure. The CDC has adopted HL7 as the standard protocol for the format and structure of the data components of messages to be communicated across the Network.
While HL7 is widely used in the healthcare industry, it is not without its deficiencies. For example, the HL7 version 2 protocol is “flat”. That is, it is not capable of sending nested information. Additionally, sometimes it is necessary to describe new events that are not part of the standard HL7 version 2 codes. As a result, new terms are implemented in free form or free text segments (so called “Z” segments). The problem with Z segments is that, by their nature, they hold information that (i) is unique to a particular institution and unlikely to be readily understood by other institutions, (ii) is of a type that cannot be accommodated in any other HL7 segment, and (iii) is in a format that is far more difficult to standardize. As a result, this dependence on the Z segment for the communication of important information undermines the utility of the HL7 “standard”.
To overcome these deficiencies, HL7 conceived the version 3 Reference Information Model (“RIM”). The RIM is a static model of health and health care information as viewed within the scope of HL7 standards development activities. The formal representation of the RIM in messages employs the extensible markup language (“XML”). The RIM was designed in part to offer a more robust message structure that could accommodate the types of information traditionally communicated in Z segments. The CDC has specified that PHIN compliant systems should use both HL7 v2.x and HL7 v3.0 RIM messages.
In attempting to achieve interoperability for systems communicating across the Public Health Information Network, the CDC has had to deal with more than a standard messaging protocol. It has identified a wide variety of functions and specifications for “PHIN-compliant” systems. For example, the effort to ensure that all PHIN systems are capable of transmitting, receiving, storing and retrieving relevant information has led it to consider the optimal structure for the database within each system. By dictating the model that each system's database must follow, the CDC apparently has tried to ensure that PHIN-compliant systems will be able to handle the widest possible spectrum of data—including data about known diseases and typical incidents, as well as diseases that are as yet undiscovered, incidents never before observed, etc. The CDC has decided that the HL7 RIM—the model for the version 3.0 messaging structure, which is designed to allow for communication of a wide variety of “non-standard” information—should serve as the model for storage and retrieval of information communicated over the PHIN. That is, the CDC is requiring that data communicated using the HL7 RIM-based messaging standard should also be the schema for a database, the model for which is “derived from or directly mappable to the RIM”. While this may seem logical to the layperson, structuring a database on a model behind a communications protocol is atypical, as the requirements that must be supported by a messaging standard are far different from those that would need to be addressed when designing an efficient, scalable database. Developing a RIM-based database that can perform up to the expectations of typical users of software solutions has proven challenging.
While PHIN-compliance is a major factor driving the need to overcome this challenge the RIM's usefulness goes beyond this regulatory impetus. A database modeled on the RIM would offer greater extensibility allowing RIM-based IT systems to better adapt to the ever-changing requirements of medical informatics necessitated by advances in medical science.
Existing healthcare IT systems (including those employed by public health officials) are likely to support communication using HL7 standards. In addition, many support HL7 v.2.x messages. However, these systems generally do not employ databases derived from or directly mappable to the RIM. The issue is further compounded in that each health institution will typically need to identify its existing data requirements, including (for example) the vocabularies it uses to label data elements, before communicating or writing that data to a database modeled on the RIM. As a result, unique implementations will be required to map each Network participant's data to a PHIN-compliant database.
In view of the foregoing, it may be useful to provide methods and systems that facilitate the mapping and storage of various disparate health-related data records to a RIM-compliant database.
The foregoing examples of the related art and limitations related therewith are intended to be illustrative and not exclusive. Other limitations of the related art will become apparent to those of skill in the art upon a reading of the specification and a study of the drawings.